1. Field of the Invention
The present invention relates to devices for repositioning an individual when seated or lying down and, more particularly, to a device for remedying and preventing decubitus "pressure" ulcers, pain and other medical maladies.
2. Description of the Related Art
A pressure ulcer is an injury usually caused by unrelieved pressure that damages the skin and underlying tissue. Pressure ulcers are also referred to as bed sores and range in severity from mild (minor skin reddening) to severe (deep craters down to muscle and bone). Unrelieved pressures on the skin squeeze peripheral blood vessels, which supply the skin with nutrients and oxygen. In general, when skin is starved of nutrients and oxygen for extended periods of time, the underlying tissue will die and a pressure ulcer may form. Pressure ulcers usually form where bone causes the greatest force on the skin and tissue and squeezes the skin and tissue against an outside surface.
This may be where bony parts of the body press against a support surface such as a mattress or chair cushion. In persons who are bedridden, most pressure ulcers form on the lower back below the waist (sacrum), the hip bone (trochanter) and the heels. For people sitting in chairs, be it conventional or wheelchairs, the exact location where pressure ulcers form depends on the prolonged sitting position. Pressure ulcers can also form on the knees, ankles, shoulder blades, back of the head and spine. Anyone confined for prolonged periods to a bed or chair, because of illness or injury, is exposed to the prospect of developing pressure ulcers.
Other scenarios may lead to the development of pressure ulcers as well. For instance, an individual subjected to repeated sliding motions in a bed or chair is exposed to the danger that blood vessels will be stretched or bent thus restricting or blocking blood circulation and resulting in the attendant risk of pressure ulcer formation. Even slight rubbing or friction on the skin may restrict blood flow causing irritation and possible minor pressure ulcers.
Nerves normally "signal" the discomfort associated with restricted peripheral circulation thus inducing the patient to move and relieve the pressure on a point or points. However, fully or partially incapacitated patients, unable to move on their own, cannot respond to the pressure induced discomfort and may develop pressure ulcers in as little as one to two hours. Individuals restricted to wheelchairs sitting in an upright position may develop pressure ulcers in even less time since the localized pressure on the effected skin and tissue tends to be greater.
Pressure ulcers pose a serious problem which may lead to pain, extended hospital or nursing home confinement, and can result in a slower recovery from health problems. In today's health care environment, the cost attendant delayed release from a hospital stay is viewed as a serious matter. The policy at many hospitals is to delay the release of patients having pressure ulcers until such ulcers are totally cured thus often increasing the duration of the stay and correspondingly driving up the cost of health care.
Fortunately, it is possible to prevent the formation of most pressure ulcers and to effectively treat those formed provided treatment is sought during the early stage. The most effective way of preventing and alleviating pressure ulcers is to simply reposition the individual periodically to shift the weight from one area to another.
Guidelines have been established for patient care facilities to follow in effort to prevent or alleviate such ulcers. For instance, a Clinical Practice Guideline, Pressure Ulcers in Adults: Predicting and Prevention (Publication #92-0047, May 1992) published by the U.S. Agency for Health Care Policy and Research, suggests that:
1. Any individual in bed who is assessed to be at risk for developing pressure ulcers should be repositioned at least every two hours; and PA1 2. Any person at risk of developing pressure ulcers should avoid uninterrupted sitting in any chair or wheelchair. The individual should be repositioned, shifting the points under pressure, at least every hour. Individuals who are able to do so, should be taught to shift their weight every 15 minutes.
Such repositioning may be accomplished, when the manpower is available, by patient care clinicians and attendants who physically move the patient at these recommended frequencies. However, hospital clinicians may inadvertently not adhere to these repositioning guidelines and, even when attempting to reposition the patient, the clinician is often faced with a difficult task in endeavoring to lift or roll the patient to new positions without exposing the patient to undue discomfort. In addition, depending on the weight of the patient and strength of the clinician, often the clinician is found to drag or slide the patient in effort to effect repositioning thus causing friction that may aggravate pressure ulcers or rub off the top layer of skin damaging underlying blood vessels.
Commonly, in the busy schedule of hospital staff, there is inadequate help available at the time a patient is to be turned thus leaving the available clinician with the dilemma of making the election to neglect the scheduled turn or undertaking the task shorthanded and exposing himself or herself to the risk of physical injury from undertaking the manipulating of a heavy load, often while assuming an awkward, high risk bending position.
In effort to overcome these apparent inadequacies, others have developed methods and devices to assist the clinician in alleviating and preventing pressure ulcers. One method is to use special mattresses that includes flowable foam, air, gel or water to equalize pressure over the surface of the body. Although these specially designed mattresses may provide some degree of relief, they have been found ineffective to completely prevent or alleviate all incidence of pressure ulcers.
Manipulating devices have been proposed with central, longitudinal hinges to pivot wings or flaps up from a horizontal support surface and to raise a flap about a transverse hinge. Devices of this type are disclosed in U.S. Pat. No. 5,224,228 to Larrimore showing a hospital bed and in U.S. Pat. No. 4,387,888 to Marinakis showing an examination table for providing limited repositioning a human body. Although these devices may provide limited relief in alleviating and preventing some pressure ulcer development, they suffer the shortcoming that they are of relatively complicated construction, expensive to manufacture and are of limited utility in cooperating with present day hospital beds having articulated frames configured to adjust the relative position of the patient's back, legs and buttocks.
Hence, it has been desirous of those skilled in the art to provide a device which can effectively and conveniently reposition a patient to multiple different orientations to alleviate or prevent the development of pressure ulcers and enhance patient comfort. Such a device should be easily operable, durable, and relatively inexpensive to manufacture. In addition, the device should be adaptable for use with and conform to patient support devices having articulated movable support surfaces and should not restrict the articulated movement incorporated therein.